The effect of gonadotrophic stimulation on integrin expression in the endometrium

BACKGROUND

Despite many recent advances in IVF treatment implantation rates per embryo transfer rarely exceed 30%. Three integrins (alpha(1)beta(1),alpha(4)beta(1) and alpha(v)beta(3)) have been shown to be expressed in the endometrium in a cyclically dependent manner and are thought therefore to play a vital role in the process of implantation.

METHODS

The effect of gonadotrophin stimulation on the expression of these three integrins within the endometrium was investigated by examining biopsies from oocyte donation patients and comparing them with fertile controls.

RESULTS

A delay in the maturation of the glandular epithelium was found in the oocyte donation patients. There was also a reduction in the expression of all three integrins in the glandular epithelium and also a reduced expression of the alpha(v)beta(3) integrin in the luminal epithelium.

CONCLUSIONS

As these integrins have been shown to be important in implantation their reduced expression after IVF treatment may have an adverse effect on pregnancy rates.

Mesalazine-induced pustular drug eruption

We describe a patient with acute generalized eosinophilic pustuloderma induced by mesalazine therapy. The patient responded to cessation of mesalazine and treatment with systemic corticosteroids. This type of unusual pustuloderma to mesalazine has not to our knowledge been described before.

A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists

The paper describes the type and frequency of adverse events and transicnt reactions following consultations with professional acupuncturists. In a postal survey, involving 1,848 professional acupuncturists, all of whom were members of the British Acupuncture Council and practising in the UK, details of adverse events and transient reactions following treatment were recorded on standardised self-report forms. A sample size of 30,000 treatments was sought, and piloting indicated that a four-week period was required. Practitioners also provided information on themselves, including age, sex, length of training and years of practice. A total of 574 practitioners responded. 31% of the total population. These practitioners reported on adverse events and transient reactions associated with 34,407 treatments. No serious adverse events were reported, where these were defined as requiring hospital admission, prolonging hospital stays, permanently disabling, or resulting in death (95% CI: 0 to 1.1 per 10,000 treatments). A total of 43 significant minor adverse events were reported, a rate of 1.3 per 1,000 treatments (95% CI: 0.9 to 1.7). These included severe nausea and actual fainting (12), unexpected, severe and prolonged aggravation of symptoms (7), prolonged and unacceptable pain and bruising (5) and psychological and emotional reactions (4). There were three avoidable events: two patients had needles left in by mistake, and one patient had moxa burns to the skin, also caused by practitioner error. The acupuncturists also recorded 10,920 mild transient reactions occurring in 5136 treatments. 15% (95% CI: 14.6 to 15.3) of the 34,407 total. In terms of local reactions, there were reports of mild bruising (1.7%), pain (1.2%) and bleeding (0.4%). Practitioners reported that patients experienced an aggravation of existing symptoms after 2.8% of treatments. The most common mild transient reactions to treatment were feeling relaxed (11.9%) and feeling energised (6.6%). In this prospective survey of 34,407 treatments, practitioners reported no serious adverse events. This conclusion was based on data collected from one in three members of the British Acupuncture Council. Given that the whole membership delivers between one and a half and two million treatments a year, this is important evidence on public health and safety. When compared with medication routinely prescribed in primary care, the results suggest that acupuncture is a relatively safe treatment modality.

Aspirin and non-steroidal anti-inflammatory drugs inhibit amyloid-beta aggregation

The neurotoxic and proinflammatory actions of the Alzheimer peptide amyloid-beta (Abeta) are dependent on its aggregation and beta-sheet conformation. Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin for arthritis decreases the risk of developing Alzheimer's disease (AD) by unknown mechanisms. We report that these drugs inhibit human Abeta aggregation in vitro and reverse the beta-sheet conformation of preformed fibrils at clinically relevant doses. Aspirin prevented enhanced Abeta aggregation by aluminum, an environmental risk factor for AD. This anti-aggregatory effect was restricted to NSAIDs and was not exhibited by other drugs used in AD therapy. NSAIDS may have a role in the prevention and treatment of AD, in addition to a number of age-related disorders such as arthritis, cardiovascular disease and cancer.

Characterization of prohibitin in a newly established rat ovarian granulosa cell line

Prohibitin is an evolutionary conserved protein that is associated with cellular differentiation, atresia, and luteolysis in the rat ovary. However, the specific cellular location and function of prohibitin in ovarian cells has not been clearly elucidated. To characterize the expression of prohibitin during cell proliferation, differentiation, and cell death, we have successfully established a temperature-sensitive granulosa cell line, designated RGA-1. At a permissive temperature of 33 C, RGA-1 cells proliferate, but revert to a differentiated phenotype at a nonpermissive temperature of 39 C. Significant inductions of prohibitin mRNA and protein expression were observed in the differentiated phenotype when compared with proliferating cells. Differentiated RGA-1 cells were found to express inhibin alpha- and beta-transcripts, as well as steroidogenic acute regulatory protein and peripheral-type benzodiazepine receptor proteins in a manner reminiscent of steroidogenic functional responses observed in primary differentiated granulosa cells. Prohibitin expression correlated well with the expression of these steroidogenic proteins. At 39 C, RGA-1 cells also displayed increases in p53 protein levels, indicative of growth arrest in the nonproliferating cells. Confocal and electron microscopic examinations revealed increased prohibitin localization to the mitochondria at 39 C, along with changes in mitochondrial size and shape. These changes were accompanied by marked reductions in cytochrome c oxidase subunit II levels and in unit mitochondrial transmembrane potential. In addition, cell fractionation studies demonstrated that the prohibitin protein was mainly localized to the mitochondrial membrane. Collectively, these findings suggest a role for prohibitin in mitochondrial structure and function during growth and differentiation in ovarian granulosa cells. Prohibitin expression may also be indicative of mitochondrial destabilization during apoptosis-related events.

Human reserve pluripotent mesenchymal stem cells are present in the connective tissues of skeletal muscle and dermis derived from fetal, adult, and geriatric donors

This study details the profile of 13 cell surface cluster differentiation markers on human reserve stem cells derived from connective tissues. Stem cells were isolated from the connective tissues of dermis and skeletal muscle derived from fetal, mature, and geriatric humans. An insulin/dexamethasone phenotypic bioassay was used to determine the identity of the stem cells from each population. All populations contained lineage-committed myogenic, adipogenic, chondrogenic, and osteogenic progenitor stem cells as well as lineage-uncommitted pluripotent stem cells capable of forming muscle, adipocytes, cartilage, bone, fibroblasts, and endothelial cells. Flow cytometric analysis of adult stem cell populations revealed positive staining for CD34 and CD90 and negative staining for CD3, CD4, CD8, CD11c, CD33, CD36, CD38, CD45, CD117, Glycophorin-A, and HLA DR-II.

Vascular endothelial growth factor and placenta growth factor concentrations in Down's syndrome and control pregnancies

Vascular endothelial growth factor (VEGF) and placenta growth factor (PLGF) are considered to play important roles in angiogenesis and vascular permeability during placental development. Since trisomy 21 placentae show trophoblastic hypoplasia and hypovascularity, we investigated PLGF and VEGF synthesis in Down's syndrome pregnancies. Maternal serum was collected from 102 euploid and 24 trisomy 21 pregnancies between 15 and 20 weeks gestation and tested for these two factors by enzyme-linked immunosorbent assays. Protein extracts from 15 normal and six trisomy 21 placentae were also tested. VEGF was not detected in maternal serum, while PLGF increased significantly with gestational age. Serum PLGF, transformed as a multiple of the gestational age median (MoM), in Down's syndrome pregnancies was significantly lower than in euploid controls (mean 0.67 +/- 0.043 MoM versus 1.00 +/- 0.047 MoM, analysis of variance F = 11.605, P < 0.001 ). Both VEGF and PLGF were detected in placental protein extracts without variation according to gestational age. Down's syndrome placentae had significantly less PLGF compared to normal placentae (Mann-Whitney, P < 0.05 ) but no difference was observed in placental VEGF content (Mann-Whitney, P = 0.94 ). Considering the biological properties of PLGF, this decrease may provide new insights into the mechanism(s) leading to the structural and functional anomalies described in trisomy 21 placentae.

Clonogenic analysis reveals reserve stem cells in postnatal mammals: I. Pluripotent mesenchymal stem cells

Clonal populations of lineage-uncommitted pluripotent mesenchymal stem cells have been identified in prenatal avians and rodents. These cells reside in the connective tissue matrices of many organs and tissues. They demonstrate extended capabilities for self-renewal and the ability to differentiate into multiple separate tissues within the mesodermal germ line. This study was designed to determine whether such cells are present in the connective tissues of postnatal mammals. This report describes a cell clone derived by isolation from postnatal rat connective tissues, cryopreservation, extended propagation, and serial dilution clonogenic analysis. In the undifferentiated state, this clone demonstrates a high nuclear-to-cytoplasmic ratio and extended capacity for self-renewal. Subsequent morphological, histochemical, and immunochemical analysis after the induction of differentiation revealed phenotypic markers characteristic of multiple cell types of mesodermal origin, such as skeletal muscle, smooth muscle, fat cells, cartilage, and bone. These results indicate that this clone consists of pluripotent mesenchymal stem cells. This report demonstrates that clonal populations of reserve stem cells are present in mammals after birth. Potential roles for such cells in the maintenance, repair, and regeneration of mesodermal tissues are discussed.

Carriage of antibiotic-resistant pneumococci among Asian children: a multinational surveillance by the Asian Network for Surveillance of Resistant Pathogens (ANSORP)

To investigate the nasal carriage of antibiotic-resistant pneumococci by children, anterior nasal swabs were done for 4963 children <5 years old in 11 countries in Asia and the Middle East. In total, 1105 pneumococci isolates (carriage rate, 22.3%) were collected, 35.8% of which were found to be nonsusceptible to penicillin. Prevalence of penicillin nonsusceptibility was highest in Taiwan (91.3%), followed by Korea (85.8%), Sri Lanka (76.5%), and Vietnam (70.4%). Penicillin resistance was related to residence in urban areas, enrollment in day care, and a history of otitis media. The most common serogroups were 6 (21.5%), 23 (16.5%), and 19 (15.7%). The most common clone, as assessed by pulsed-field gel electrophoresis, was identical to the Spanish 23F clone and to strains of invasive isolates from adult patients. Data in this study documented the high rate of penicillin or multidrug resistance among isolates of pneumococci carried nasally in children in Asia and the Middle East and showed that this is due to the spread of a few predominant clones in the region.

Couch or crouch? Examining the prostate: a randomized study comparing the knee-elbow and the left-lateral position

OBJECTIVE

To compare two methods of examining the prostate, the knee-elbow (KE) and left-lateral (LL) positions, to establish which allows a more complete examination, and to determine if there is any difference in patients' perception of pain or embarrassment for either method.

PATIENTS AND METHODS

All men attending two urology clinics who required a prostate examination were eligible for the study. Both the KE and LL methods were used for each participant, by the same clinician. The order in which the examinations were conducted was randomized using the last digit of the patient's hospital number.

RESULTS

Five clinicians examined 117 men; three patients refused to participate and the examination data were incomplete for two. Irrespective of the order in which the examinations were conducted (P = 0.6), the KE position permitted a greater proportion of the prostate to be palpated (Wilcoxon signed-ranks test, z = -4.7, P < 0.001) in 35% of patients, but there was no difference in 60%. Most patients found the examinations equally painful and embarrassing. However, for those who expressed a difference, the KE was 1.9 times more comfortable than the LL position and twice as embarrassing.

CONCLUSION

The two methods of prostate examination were equal for completeness of examination, pain and embarrassment in most patients. However, the KE offers an alternative to the LL position for those patients in whom the prostate is difficult to palpate or who find the examination painful.

Respiratory syncytial virus infection results in activation of multiple protein kinase C isoforms leading to activation of mitogen-activated protein kinase

Respiratory syncytial virus (RSV) is an important respiratory pathogen that preferentially infects epithelial cells in the airway and causes a local inflammatory response. Very little is known about the second messenger pathways involved in this response. To characterize some of the acute response pathways involved in RSV infection, we used cultured human epithelial cells (A549) and optimal tissue culture-infective doses (TCID(50)) of RSV. We have previously shown that RSV-induced IL-8 release is linked to activation of the extracellular signal-related kinase (ERK) mitogen-activated protein kinase pathway. In this study, we evaluated the upstream events involved in ERK activation by RSV. RSV activated ERK at two time points, an early time point consistent with viral binding and a later sustained activation consistent with viral replication. We next evaluated the role of protein kinase C (PKC) isoforms in RSV-induced ERK kinase activity. We found that A549 cells contain the Ca(2+)-dependent isoforms alpha and beta1, and the Ca(2+)-independent isoforms delta, epsilon, eta, mu, theta, and zeta. Western analysis showed that RSV caused no change in the amounts of these isoforms. However, kinase activity assays demonstrated activation of isoform zeta within 10 min of infection, followed by a sustained activation of isoforms beta1, delta, epsilon, and mu 24-48 h postinfection. A cell-permeable peptide inhibitor specific for the zeta isoform decreased early ERK kinase activation by RSV. Down-regulation of the other PKC isoforms with PMA blocked the late sustained activation of ERK by RSV. These studies suggest that RSV activates multiple PKC isoforms with subsequent downstream activation of ERK kinase.

An analysis of burst fractures of the spine in adolescents

Burst fractures are less common in children than in adults because of the greater mobility and elasticity of the pediatric spine. Because of these spine characteristics, these fractures may behave differently in childhood than in adulthood. To try to address these differences, we reviewed our experience with 11 children (5 boys, 6 girls) treated for burst fractures. Average age at time of injury was 14.4 years. Follow-up averaged 9 years. All fractures were categorized using the Denis classification system for burst fractures. Three children had associated spinal cord injury. Five children were treated with nonoperative bedrest and casting; the other 6 children, who had the most severe burst fractures, were treated with posterior spinal fusion and instrumentation. Satisfactory functional results were found in 90% of the children at follow-up. Radiological evaluation at initial and follow-up examination showed that children treated operatively improved or maintained their fracture kyphosis (range, 12 degrees - 19 degrees). Anterior vertebral compression improved an average of 15% (range, 24%-39%). In the children treated nonoperatively, kyphosis progressed an average of 9 degrees (range, 15 degrees - 24 degrees), and anterior vertebral compression increased a further 8% (range, 36%-44%). Our results showed that (a) the children who sustained burst fractures tended to develop mild progressive angular deformity at the site of the fracture, (b) operative stabilization prevented further kyphotic deformity as well as decreased the length of hospitalization without contributing to further cord compromise, and (c) nonoperative treatment of burst fracture was a viable option in neurologically intact children, but progressive angular deformity occurred during the first year after the fracture.

A polymerase chain reaction-enzyme immunoassay for diagnosis of pneumococcal meningitis in children and adults

BACKGROUND AND OBJECTIVES

meningitis due to Streptococcus pneumoniae is common among children and adults. In this study a polymerase chain reaction (PCR) for diagnosis of pneumococcal meningitis was evaluated prospectively.

METHODS

a total of 61 cerebrospinal fluid specimens were included prospectively using defined inclusion and exclusion criteria. These samples were studied by PCR-EIA and results compared with conventional microbiological procedures and antigen detection techniques. Primers were used against the conserved region of the pneumococcal autolysin gene and the amplified product was labelled using the digoxigenin-labelled dUTP. The product was detected by an enzyme immuno assay (EIA) after hybridization with a biotin labelled probe.

RESULTS

a total of 15 specimens were positive for S.pneumoniae by one or more methods used. Culture for S.pneumoniae was positive in 13 specimens, PCR-EIA was positive in 11 of these specimens with an additional pickup of 2 specimens and latex agglutination (LA) positive only in one.

INTERPRETATION AND CONCLUSIONS

sensitivity and specificity of 84.6 and 95.8 per cent respectively were observed with PCR-EIA. It seems to be a good tool for the diagnosis of pneumococcal meningitis especially in cases of partially treated pyogenic meningitis.

Stimulation of Hyaluronan synthetase by platelet-derived growth factor bb in human prostate smooth muscle cells

Hyaluronic acid (HA) is an important component of the extracellular matrix of prostate cells. Platelet-derived growth factor bb (PDGFbb) has a mitogenic effect on prostate stromal cells. The effect of PDGFbb on HA production by smooth muscle cells from normal and benign prostatic hyperplasia (BPH) tissue was studied to elucidate the role of these two factors in BPH. The basal level of HA released into the cell media was greater in BPH cells. PDGFbb increases HA production in normal and BPH smooth muscle cells. This is partly due to an increase in HA synthetase II mRNA expression. In prostate disease, PDGFbb may have a role that involves HA production.

Inhibin subunits mRNA expression level in human placenta from normal and Down's syndrome pregnancies

In order to study the mechanisms leading to increased inhibin A and activin A in maternal serum with advancing gestation and increased inhibin A in Down's syndrome pregnancy, the mRNA expression level of inhibin and activin subunits was quantitatively studied in human placenta using Northern blot and semiquantitative RT-PCR analysis. The corresponding protein level was also determined by specific ELISAs for inhibin A, inhibin B, activin A and inhibin pro alphaC in placental extracts. Normal placenta (n=27) showed a slight significant increase in alpha and betaA subunit mRNA levels in term pregnancy, with no change of the corresponding protein level. Placenta from Down's syndrome pregnancies (n=6) did not differ from controls in either mRNA expression or corresponding protein levels. In conclusion, there is a dissociation between inhibin and activin subunit mRNA levels and the corresponding protein levels in maternal serum, and Down's syndrome inhibin A increase is not explained by mRNA expression upregulation. In an additional study, ovarian cortex tissue from term pregnancies (n=3) were examined. Only the alpha subunit mRNA was expressed, at a higher level than in the placenta, suggesting that ovary could be a source of inhibin pro alphaC during pregnancy.